A case of takotsubo cardiomyopathy leading to the diagnosis of myasthenia gravis

Abstract

A 52-year-old woman presenting with shortness of breath and having no related past medical history was diagnosed with takotsubo cardiomyopathy. However, she revealed respiratory failure atypical with takotsubo cardiomyopathy. We diagnosed myasthenia gravis with myasthenic crisis by acetylcholine receptor-binding antibody titer with mediastinal tumor. Physical or emotional stress is well known to trigger the onset of takotsubo cardiomyopathy. Similarly, myasthenia crisis is also triggered by stress. Here, we report a case of simultaneous occurrence of takotsubo cardiomyopathy and myasthenia crisis.

Defining Features of Patients who Develop Takotsubo Cardiomyopathy during Myasthenic Crisis: A Systematic Review of Case Studies

“…All studies were case reports published between 2005 and 2018. USA [8,9,10,12,18] and Asia [7,11,15,16,20] each conducted 5 studies, while 3 took place in Europe [13,14,19]. South America contributed to 1 study only [17].…”

“…5 articles did not mention any other complications [8,9,10,17,20]. Five articles emphasized a previous history of thymectomy [12] or thymoma [11,13,16,18]. The gradings for thymomas were B1 [16] or B2 [13,18].…”

“…Five articles emphasized a previous history of thymectomy [12] or thymoma [11,13,16,18]. The gradings for thymomas were B1 [16] or B2 [13,18]. 4 articles observed pulmonary edema as a complication during the myasthenic crisis [7,11,13,14], while 2 articles reported QT prolongation and Torsades de Pointes [15,19].…”

“…The average age for European studies was 73.7 years. 4 articles described male patients with an average age of 64.1 years [8,12,14,17], while the remaining 10 studies of female patients had an average age of 60.5 years [7,9,10,11,13,15,16,18,19,20]. Common medical history aside from myasthenia gravis and change in thyroid function included atrial fibrillation [13,15,19] and hypertension [9,13,14].…”

“…All studies reported respiratory distress, which encompassed breathlessness, shortness of breath, wheezing, respiratory failure, or respiratory muscle paralysis [7–20]. The next common presentation was generalized weakness and fatigue (71.4%) [7–11,14,16,17,19,20] followed by dysphagia (57.1%) [7 ,8,9,10,14,15,18,19] and then equally ocular problems involving either ptosis or diplopia [7,8,9,10,16,19] or dysarthria (42.9%) [7,8,9,13,14,19]. Chest pain was only reported in 21.4% of the cases [9,17,20].…”